News:

a.Rhesus

Rh -ve young female recipients with Rh +ve donor require anti D immunoglobulin at induction (can be given up to 72 hours later if overlooked initially).

b.Hepatitis B

I.HBsAg-, HBcAb+ renal tx recipients

Before renal transplant surgery, if time allows, check the HBsAb levels and give a booster dose if levels are <10 mIU/mL; otherwise, give a booster dose regardless of HBsAb levels unless one was given in the previous 8 weeks.

Monitor HBsAg monthly for the first 3 months post-transplant surgery, and every 3-4 months subsequently for at least a year.

II.HBsAg-, HBcAb- renal tx recipient with HBsAg-, HBcAb+ renal donor

Before renal transplant surgery, if time allows, check the HBsAb levels and give a booster dose if levels are <10 mIU/mL; otherwise, give a booster dose regardless of HBsAb levels unless one was given in the previous 8 weeks.

At the time of renal transplant surgery, give HBV immunoglobulin (HBIG) according to the following schedule:

HBIG 4,000 IU iv stat.

Measure HBsAb levels at day 7 and repeat dose if levels are <500 mIU/mL.Monitor HBsAg monthly for the first 3 months post-transplant surgery, and every 3-4 months subsequently for at least a year.

c.Fasting Type I Diabetic patients

In practice, all fasting type I diabetic patients go on a sliding scale as shown below (taken from Lothian Adult Medical Emergencies Handbook). All patients need a background fluid infusion; we would suggest 20mls/hour of 10% dextrose as most patients are anuric.